03 Nov How Well Does the “Surprise Question” Predict Mortality in Cancer Patients?
MedicalResearch.com Interview with:
Kristine Gade, MD
UPMC Hillman Cancer Center
MedicalResearch.com: What is the background for this study? Would you briefly describe the “surprise question”?
Response: Via Oncology Pathways, a cancer care platform used by UPMC and other institutions across the country, asks physicians to answer the surprise question – “Would I be surprised if this patient died in the next 12 months?” – whenever a new treatment plan is implemented. This question has been widely adopted by many oncology and palliative care frameworks and has been shown to be modestly predictive of mortality in multiple studies. We know that advanced cancer patients have a high utilization of the emergency department, even near end of life. Our group wanted to see if we could use the results of the surprise question to easily and quickly communicate to emergency department providers the expected prognosis for our advanced cancer patients. First, we set out to assess the surprise question’s ability to predict survival among our UPMC Hillman Cancer Center patients with select stage IV cancer diagnoses.
MedicalResearch.com: What are the main findings?
Response: An answer of “No, I would not be surprised if this patient died in the next 12 months” was more likely to predict 12-month mortality. For patients who died within a year, 63.1% had an answer of “No, I would not be surprised” compared to 32.5% with “Yes, I would be surprised”. The sensitivity of the surprise question was calculated at 71.4% and specificity at 58.7%.
MedicalResearch.com: What should readers take away from your report?
Response: The surprise question was only modestly predictive of 12-month mortality among our UPMC Hillman Cancer Center patients. However, this a quick and easy way of assessing a provider’s expectation of prognosis and may be useful to communicate this information to other providers.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: Our group plans to look at several other aspects of the surprise question in relation to health care utilization. We would like to see how a response of “No, I would not be surprised if this patient died in the next 12 months” affects emergency department visits and inpatient admissions, palliative care referrals, ICU utilization and any treatment in the last month of life.
Kristine Gade, Neal Spada, Ellen Ormond, Mamta Bhatnagar, Maria Guyette, Aaron Brown, Kevin Cullison, and Roby Antony Thomas
Journal of Clinical Oncology 2020 38:29_suppl, 25-25
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